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CC BY-NC-ND 4.0 · International Journal of Practical Otolaryngology 2022; 05(01): e29-e38
DOI: 10.1055/s-0042-1758860
Original Article

Reevaluation of the Merits and Demerits of Prophylactic Gastrostomy in Patients with Head and Neck Cancer Undergoing Concurrent Chemoradiotherapy

Ryosuke Kitoh
1   Department of Otorhinolaryngology and Head and Neck Surgery, Shinshu University School of Medicine, Matsumoto-shi, Nagano, Japan
,
Yoh-ichiro Iwasa
1   Department of Otorhinolaryngology and Head and Neck Surgery, Shinshu University School of Medicine, Matsumoto-shi, Nagano, Japan
,
Yoh Yokota
1   Department of Otorhinolaryngology and Head and Neck Surgery, Shinshu University School of Medicine, Matsumoto-shi, Nagano, Japan
,
Kazuki Matsuura
1   Department of Otorhinolaryngology and Head and Neck Surgery, Shinshu University School of Medicine, Matsumoto-shi, Nagano, Japan
,
Yutaka Takumi
1   Department of Otorhinolaryngology and Head and Neck Surgery, Shinshu University School of Medicine, Matsumoto-shi, Nagano, Japan
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Abstract

Concurrent chemoradiotherapy (CCRT) is one of the standard treatment strategies for patients with locally advanced head and neck squamous cell carcinoma (HNSCC). Prophylactic percutaneous gastrostomy (pPEG) has been reported to be useful for nutritional intervention during CCRT. On the other hand, disadvantages such as complications of gastrostomy itself and long-term PEG dependence have also been reported. In the present study, we conducted a retrospective review of the data of HNSCC cases treated with CCRT and reevaluate the merit and demerit of pPEG. Patients with pharyngeal carcinoma treated by CCRT between 2015 and 2020 were enrolled for this analysis. In this study, we limited our analysis to those who received the following treatments: Radiation therapy was planned for a total dose of 70 Gy, and the concomitant chemotherapy regimen was high-dose (100 mg/m2) CDDP administered intravenously once every three weeks (three cycles). A total of 54 patients who underwent pPEG met the inclusion criteria. Fifteen patients who had received similar treatment without pPEG during the study period were used as a control group for comparison. The results revealed that in the pPEG group, there were fewer cases with a weight loss of 10% or more, nutritional intervention was started relatively early, and the hospitalization period after the end of CCRT was shorter as compared with the status in the non-PEG group. In regard to PEG tube dependence, the rate of PEG tube usage at 6 months after CCRT was relatively low, at approximately 13%. No significant factor was identified in this study regarding the need for nutritional intervention by routes, including PEG tube, nasogastric tube, and total parenteral nutrition, other than oral intake. In the review of the literature, it seemed difficult to make a simple comparison due to the lack of uniformity in the selection criteria for pPEG, patient background, and treatment intensity.

Keywords

prophylactic percutaneous endoscopic gastrostomy - head and neck cancer - concurrent chemoradiotherapy

Informed Consent

This study was approved by Shinshu University Ethical Committee and informed consent was obtained in the form of opt?out on the web site.




Publication History

Received: 20 April 2022

Accepted: 29 July 2022

Article published online:
13 December 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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